Cannabidiol (CBD) has been recently covered in the media, and you may have even seen it as an add-in booster to your post-workout smoothie or morning coffee. What exactly is CBD? Why is it suddenly so popular?
CBD may offer an option for treating different types of chronic pain. A study from the European Journal of Pain showed, using an animal model, CBD applied on the skin could help lower pain and inflammation due to arthritis. Another study demonstrated the mechanism by which CBD inhibits inflammatory and neuropathic pain, two of the most difficult types of chronic pain to treat. More study in humans is needed in this area to substantiate the claims of CBD proponents about pain control.
How is cannabidiol different from marijuana?
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CBD is commonly used to address anxiety, and for patients who suffer through the misery of insomnia, studies suggest that CBD may help with both falling asleep and staying asleep.
CBD has been touted for a wide variety of health issues, but the strongest scientific evidence is for its effectiveness in treating some of the cruelest childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically don’t respond to antiseizure medications. In numerous studies, CBD was able to reduce the number of seizures, and, in some cases, it was able to stop them altogether. Videos of the effects of CBD on these children and their seizures are readily available on the Internet for viewing, and they are quite striking. Recently the FDA approved the first ever cannabis-derived medicine for these conditions, Epidiolex, which contains CBD.
Cooper recently got funding from the National Institutes of Health for a study looking at cannabinoids — including CBD in isolation — as a substitute for opioids, and numerous other 2 come from products that contain THC as well as CBD, Cooper said, but we need to do more studies to find out for sure whether CBD has fewer risks. Studies are also needed to identify the best way to administer and dose CBD. “I get emails from people asking me what dose of CBD to use, and the truth is, we really don’t know,” Cooper said.
Those warning letters aside, there’s not a lot of federal oversight right now over the claims being made or the products that are being sold. Cohen warned against buying CBD products online, because “there’s a lot of scams out there.” Yet his clinic sells CBD, and he admits, “I say ‘Don’t buy online,’ but ours is worth doing, because we know what we’re doing. We ship all over.”
Still, as the saying goes, absence of evidence isn’t necessarily evidence of absence, and there’s a reason we don’t have a ton of solid research on CBDs yet — “to study it, we need a good source, ” said Ziva Cooper, who is an associate professor at Columbia University and was on the National Academies committee. CBD is hard to get because it’s still technically a Schedule I drug, which limits its availability, Cooper said.
Most of these products promised to relieve pain or otherwise enhance well-being, and none of it was cheap. (Prices started at about $30.) But I wanted to know: Does any of this stuff really work? After a deep dive into the scientific research, I learned that the answer was a big fat maybe.
Cannabinoids are a class of compounds that interact with receptors throughout your body. CBD is just one of dozens of cannabinoids found in cannabis, including tetrahydrocannabinol (THC), which is the one responsible for marijuana’s famous high. Medical cannabis is technically any cannabis product used for medicinal purposes, and these can contain THC or CBD or both, said Nick Jikomes, a neuroscientist at Leafly, a website that provides information about legal cannabis. “A common mistake people make is to think that CBD is ‘the medical cannabinoid’ and THC is ‘the recreational cannabinoid.’” That’s inaccurate, he said, because THC is a potent anti-inflammatory and can be helpful for pain.
Last year, the National Academies of Sciences, Engineering and Medicine released a nearly 500-page report on the health effects of cannabis and cannabinoids. A committee of 16 experts from a variety of scientific and medical fields analyzed the available evidence — more than 10,000 scientific abstracts in all. Because so few studies examine the effects of CBD on its own, the panel did not issue any findings about CBD specifically, but it did reach some conclusions about cannabis and cannabinoids more generally. The researchers determined that there is “conclusive or substantial evidence” supporting the use of cannabis or cannabinoids for chronic pain in adults, multiple sclerosis-related spasticity (a kind of stiffness and muscle spasms), and chemotherapy-induced nausea and vomiting. The committee also found “moderate” evidence that cannabis or cannabinoids can reduce sleep disturbances in people with obstructive sleep apnea, fibromyalgia, chronic pain and multiple sclerosis, as well as “limited” evidence that these substances can improve symptoms of Tourette’s syndrome, increase appetite and stem weight loss in people with HIV/AIDs, and improve symptoms of PTSD and anxiety.
Although there’s enticing evidence that good ol’ cannabis can ease chronic pain and possibly treat some medical conditions, whether CBD alone can deliver the same benefits remains an open question. What is clear, at this point, is that the marketing has gotten way ahead of the science.
McGuire would now like to do a worldwide trial of cannabidiol in large samples to see whether it can be a medicine, not just a research tool. “Patients with psychosis have a life expectancy that’s about 20 years shorter than normal, and that’s because psychosis is associated with poor physical health, especially cardiovascular health,” he says. “And it’s possible that – this has never been tested – but another benefit of cannabidiol in these patients is that it could help with their physical health problems.”
The distinction for McGuire is that CBD is a nutriceutical – in common with minerals and vitamins – not a pharmaceutical product. This is in large part due to its origins. Cannabidiol was not developed as a new blockbuster drug by a pharmaceutical giant or a medicine to which nobody else had access. Instead, the compound has emerged relatively organically, and pretty much anyone can produce a version of CBD without infringing patent laws. (GW can only patent what is called the “formulation” of Epidiolex.) If you’re no fan of big pharma, this has some advantages: CBD can become widely available and competitively priced. But the downside is that cannabidiol products are not subject to the clinical trials and randomised, double-blind assessments that we might expect from a supplement we are taking to improve our health.
After the accident, Horn did sessions of cognitive behavioural therapy, which he found helpful. He didn’t take antidepressants, because he was concerned about the side-effects; he did smoke cannabis, though he didn’t always like feeling stoned. “I suffered from some PTSD symptoms, flashbacks,” he says. “And some other issues.”
The ‘high tea’ at Camilla Fayed’s restaurant Farmacy. Photograph: Robin Goodlad
In the past five years, McGuire has moved on to do clinical trials of cannabidiol in patients with psychosis, or people who are vulnerable to psychosis. The tests have been done against a placebo, double-blind, and again the results are very encouraging. “We’ve done two phase-two trials and, in both of these, found that cannabidiol reduced psychotic symptoms more than the placebo did,” he says. “So it wasn’t a placebo effect, it really did reduce psychotic symptoms.”
Charlotte Caldwell and her son Billy, who uses a purified form of cannabidiol to control his epilepsy. Photograph: Yui Mok/PA
Hearing these testimonies, it would seem perverse, even neglectful, not to use CBD, but where to start? One option is High Tea at Farmacy, a plant-based restaurant in west London. On the menu are a CBD-infused vodka cocktail, CBD truffles (tahini and dark chocolate, and basmati and coconut) and a pot of hemp leaf tea. With extras, it costs £42. “You don’t technically get high from it, it’s just a great play on words,” says Camilla Fayed, who opened Farmacy in 2016. “It definitely draws people in.”